Prospects for new interventions in the treatment and prevention of mycobacterial disease

Mycobacterium tuberculosis claims more lives each year than any other single human pathogen. Despite the availability of effective drugs, the incidence of tuberculosis is increasing in much of the developing world and has recently reemerged as a public health problem in industrialized countries. In the first section of this chapter, current understanding of the fundamental biology of mycobacterial infection is reviewed from the perspective of development of new tools for disease control. A second section describes strategies for identification of novel antimycobacterial agents, with particular emphasis on recent progress in defining biosynthetic pathways for unique mycobacterial cell wall components. The third section focuses on current approaches to the development of new vaccine candidates consisting of live attenuated bacteria or individual antigenic subunits.